芪明颗粒治疗糖尿病肾病临床疗效的Meta分析  

Efficacy and Safety of Qiming Granules(芪明颗粒)for Diabetic Nephropathy:A Meta-Analysis

作　　者：洪卓民 罗向霞[2] 曾敏 苏梅贵 周茹玉 HONG Zhuomin;LUO Xiangxia;ZENG Min;SU Meigui;ZHOU Ruyu(Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China;Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,Gansu,China)

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省中医院,甘肃兰州730050

出　　处：《实用中医内科杂志》2022年第8期21-25,I0009-I0012,共9页Journal of Practical Traditional Chinese Internal Medicine

基　　金：国家自然科学基金(81960888);兰州市人才创新创业项目(2019-RC-62)。

摘　　要：目的系统评价芪明颗粒治疗糖尿病肾病的有效性和安全性,为临床用药提供循证参考。方法计算机检索CNKI、VIP、WanFang、CBM、PubMed、Cochrane Library、Embase数据库,搜集芪明颗粒治疗糖尿病肾病随机对照试验(RCT)的中英文文献,检索时限均为各数据库建库起至2021年7月1日。筛选文献、提取数据后,采用Cochrane系统评价员手册推荐的5.1.0偏倚风险评估工具对纳入文献质量进行评价。采用RevMan 5.3软件进行Meta分析。结果共纳入9项RCT,共计1056例患者。Meta分析结果显示,芪明颗粒治疗组在降低空腹血糖[SMD=-1.27,95%CI(-1.55,-0.98),P<0.00001]、24 h尿微量白蛋白排泄率[SMD=-1.90,95%CI(-3.05,-0.75),P=0.001]、血肌酐[SMD=-1.16,95%CI(-1.72,-0.60),P<0.0001]、血尿素氮[SMD=-2.42,95%CI(-3.66,-1.18),P=0.0001]、甘油三酯[SMD=-1.21,95%CI(-1.94,-0.48),P=0.001]、总胆固醇[SMD=-1.01,95%CI(-1.69,-0.34),P=0.003]、低密度脂蛋白[SMD=-1.14,95%CI(-1.65,-0.63),P<0.0001]方面均优于常规治疗组;而在降低糖化血红蛋白方面受疗程的影响,疗程12周[SMD=-0.17,95%CI(-0.83,0.48),P=0.60]两组疗效相当;疗程≥16周[SMD=-1.21,95%CI(-1.59,-0.82),P<0.00001]时芪明颗粒治疗组优于常规对照组。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。敏感性分析结果显示,以治疗后空腹血糖、血肌酐为指标时,剔除异质性来源后的分析结果与剔除前比较无显著差异。结论芪明颗粒治疗可显著提高糖尿病肾病的疗效。由于纳入研究质量不一,确切结论尚需更多高质量的RCT加以验证。Objective To systematically evaluate the effectiveness and safety of Qiming Granules(芪明颗粒)in the treatment of diabetic nephropathy and provide evidence-based reference for clinical medication.Methods A computer search of CNKI,VIP,WanFang,CBM,PubMed,Cochrane Library and Embase databases and a collection of Chinese and English literature on the randomized controlled trial(RCT)of Qiming Granules in the treatment of diabetic nephropathy were carried out.The search time was from the establishment of each database until July 1st,2021.After screening the literature and extracting the data,the 5.1.0 bias risk assessment tool recommended by the Cochrane System Reviewer Manual was used to evaluate the quality of the included literature.RevMan 5.3 software was used for Meta-analysis.Results A total of 9 RCTs were included,with a total of 1056 patients.Meta-analysis results showed that Qiming Granules treatment group decreased the levels of fasting blood glucose[SMD=-1.27,95%CI(-1.55,-0.98),P<0.00001],24 h urine microalbumin excretion rate[SMD=-1.90,95%CI(-3.05,-0.75),P=0.001],blood creatinine[SMD=-1.16,95%CI(-1.72,-0.60),P<0.0001],blood urea nitrogen[SMD=-2.42,95%CI(-3.66,-1.18),P=0.0001],triglycerides[SMD=-1.21,95%CI(-1.94,-0.48),P=0.001],total cholesterol[SMD=-1.01,95%CI(-1.69,-0.34),P=0.003]and low-density lipoprotein[SMD=-1.14,95%CI(-1.65,-0.63),P<0.0001]more obviously than the conventional treatment group.While the reduction of glycosylated hemoglobin was affected by the course of treatment.The effect of the two groups was not significant in the treatment of 12 weeks[SMD=-0.17,95%CI(-0.83,0.48),P=0.60].When the treatment course was more than 16 weeks,the treatment group had better effect than the conventional control group[SMD=-1.21,95%CI(-1.59,-0.82),P<0.00001].There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Sensitivity analysis showed that when fasting blood glucose and serum creatinine were taken as the indicators after treatment,there wa

关 键 词：糖尿病肾病 芪明颗粒 疗效性 血糖 尿微量白蛋白排泄率 安全性 META分析 系统评价 

分 类 号：R259[医药卫生—中西医结合]